Empowering Fall Prevention Through Integrated Lifestyle Medicine Strategies—From Recognition of Fall Risks to Implementation of Prevention of Falls for all in Practice

Abstract

Falls remain the leading cause of unintentional injuries across all age groups, prompting many emergency room visits. The annual estimated cost associated with falls is believed to exceed 100 billion dollars. In addressing this trend, health professional team members emerge as key players and can assume a crucial role in bridging the gap between lifestyle medicine and fall prevention. By imparting strategies aligned with the 6 pillars of lifestyle medicine, these professionals can educate individuals on risk factors, assess fall risk, and offer activities to mitigate the likelihood of future falls. This collaborative approach empowers all to take immediate and informed action, fostering a proactive stance against the prevalent issue of fall-related injuries. Through the background and practical strategies described in this paper, health professionals of various disciplines will have access to tools and knowledge to enhance their role in preventing falls using the lens of lifestyle medicine.

“Assessing lifestyle factors across the 6 pillars of lifestyle medicine provides valuable insights into an individual's fall risk.”

Introduction

What makes the four-letter F-word “F-A-L-L” so dirty? According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of unintentional injuries, resulting in emergency room visits across all age groups.^1,2 These injuries carry an estimated annual economic burden exceeding $100 billion. Falls remain the number 1 cause of traumatic brain injuries and are responsible for over 95% of hip fractures. ³ These are only a few statistics that highlight this dirty 4-letter F-word. Unfortunately, falls are still on the rise. ² Particularly in the older adult population, there is an upward trend that predicts 7 fall deaths every hour by the year 2030 if fall rates continue to rise.²

There are many misconceptions about falls. Most falls are preventable. They are, in fact, not a normal part of aging. Also, they do not only happen to older adults; they are a concern that affects those of all ages. Some fall risk factors are associated with the lifestyle medicine pillars of nutrition, physical activity, sleep health, stress management, social connections, and avoidance of risky substances. Optimizing these very pillars can help decrease the risk of falling. The following are 3 learning objectives of this review paper:

• (1) Understand risk factors for falls using a lifestyle medicine lens and integrate the 6 pillars for a comprehensive understanding.

• (2) Assess the risk of falling by utilizing practical evaluation strategies.

• (3) Communicate fall prevention interventions, emphasizing the connection between lifestyle behaviors and fall risk.

Objective 1

Understand risk factors for falls using a lifestyle medicine lens and integrate the 6 pillars for a comprehensive understanding.

Nutrition and Fall Risk

Proper nourishment plays a crucial role in reducing fall risk. For example, inadequate protein intake can lead to decreased muscle mass and diminished physical performance, both of which increase susceptibility to falls. ⁴

Body Mass Index (BMI), another measure associated with diet, has also been linked to fall risk. A 2018 systematic review revealed a U-shaped association between BMI and incidence of falls in adults over 65 years of age. Interestingly, the lowest fall risk was observed in individuals with a BMI between 26 and 28—a range classified as overweight. ⁴ However, as BMI moves into either the underweight or obese categories, the risk of falling increases. ⁴

Hydration also plays a vital role in maintaining balance and stability. Dehydration is associated with symptoms such as dizziness, fatigue, weakness, and impaired concentration, all of which elevate the risk of falls. ⁵

Finally, vitamin D deficiency can further exacerbate fall risk by contributing to muscle weakness, osteoporosis, and impaired balance and mobility. ⁶ Addressing these nutritional factors is essential for maintaining physical strength, stability, and overall fall prevention.

Sleep and Fall Risk

Both insufficient sleep and poor-quality sleep—whether due to short sleep duration, fragmented sleep (frequent awakenings), difficulty falling or staying asleep, or sleep disorders such as insomnia and obstructive sleep apnea—are strongly associated with an increased risk of falling.^7,8

Sleep deprivation has wide-ranging effects on the body and mind that exacerbate fall risk. It increases the likelihood of many chronic diseases, including heart disease, diabetes, hypertension, stroke, and obesity. It also impairs reaction time—a critical factor given that the window to recover from a substantial disturbance of balance and avoid a fall is often less than 1 second. Sleep deprivation further triples the fear of falling in some adults, compounding other pre-existing risks, and reduces the brain’s ability to clear waste products through the glymphatic system, potentially affecting cognitive and physical function. ⁹

A 2016 systematic review and meta-analysis highlighted a U-shaped relationship between sleep duration and fall risk. ¹⁰ The lowest risk of falls was observed in individuals who consistently achieved 7-8 hours of sleep per night. Deviating from this range—whether sleeping too little or too much—was associated with an increase in fall risk. ¹⁰

De-Stress and Fall Risk

Stress is a contributor to fall risk, affecting both the body and mind in ways that compromise stability and safety. One of the primary effects of stress is increased muscle tension, which acts as a barrier to smooth, coordinated movement.^11,12 As stress levels rise, muscles can become progressively tighter, leaving the body less equipped to respond effectively to unexpected slips, trips, or stumbles.

Stress also impacts breathing patterns, often leading to shallow, mouth-dominated breathing. While nostril breathing activates the parasympathetic nervous system and helps regulate stress levels, mouth-breathing exacerbates stress and can weaken or restrict the diaphragm. ¹³ The diaphragm plays a crucial role in core stability, which is essential for maintaining upright balance. If the diaphragm is compromised, overall stability is likely to be affected. ¹⁴

Additionally, stress can impair focus, making individuals more prone to distractions and less aware of their surroundings—factors that increase the likelihood of missing physical hazards. ¹⁵ Stress may also encourage hurried movements, causing individuals to push their bodies beyond their normal pace, further heightening fall risk.^16,17

Clearly, stress is not just a mental challenge; it disrupts physical systems in ways that undermine balance and increase vulnerability to falls.

Social Connections and Fall Risk

Social connections are vital not only for overall health and well-being but also, indirectly, for reducing the risk of falls. For example, during the COVID-19 pandemic, social isolation was strongly associated with increased loneliness, depression, and reduced physical activity—all factors that elevate fall risk. ¹⁸

The influence of social connections extends beyond companionship; they shape attitudes, beliefs, values, and behavior patterns, which also can significantly affect fall risk. ¹⁹ However, it is not merely the quantity of social interactions that matters, but the quality of those relationships. Negative social connections—such as spending time with individuals who induce stress, reduce motivation, or contribute to fatigue—can have detrimental effects on physical and mental well-being.^20,21

In contrast, positive social connections can provide numerous benefits, including reduced stress, increased confidence, enhanced motivation, and improved physical activity levels. These factors collectively contribute to a lower risk of falling, emphasizing the importance of cultivating supportive and meaningful relationships.^20,21

Risky Substances and Fall Risk

Many substances can contribute to fall risks, but here we focus on 3 of the most encountered: alcohol, opioids, and smoking.

Alcohol

Alcohol is the most commonly consumed risky substance and is well-documented to impair balance, judgment, and reaction time. The correlation between alcohol consumption and fall risk is clear: the more individuals drink, the higher their risk. However, even small amounts can be dangerous. A 2011 systematic review found that consuming as little as 10 grams of alcohol increases the risk of sustaining an injurious fall by 25%. ²²

To put this into perspective, according to the CDC, a standard drink contains approximately 14 grams (0.49 ounces) of pure alcohol. ²³ This means that consuming just 1 drink could exceed 10 grams (0.35 ounces) of alcohol, already raising the risk of an injurious fall.^23,24

Opioids

The risks associated with opioids have been a major focus in recent years, particularly concerning their role in addiction and overdose. However, less attention has been given to their impact on fall risk. An Australian study involving over 3 million adults prescribed opioids revealed that 10% of individuals aged 18 and older experienced a serious fall. ²⁵ Similar to alcohol and other substances, the risk associated with opioid use increases with dosage, with the first 28 days of use presenting the highest risk.^25-29

The risk associated with opioid use, similar to alcohol and other prescription medications, increases with dosage.^22,25-29 Notably, the first 28 days of opioid use present the highest risk of falls. ²⁵

Smoking

Although the data linking cigarette smoking to fall risk is somewhat limited, the association becomes clearer when considering its short- and long-term effects.^30,31 Short-term impacts, such as dizziness, light-headedness, nystagmus, and unsteadiness, can directly increase the likelihood of a fall. Over time, smoking may lead to peripheral neuropathy, reduced bone density, impaired blood flow, and respiratory issues, all of which further elevate fall risk. ³²

Physical Activity and Fall Risk

Seventy-five percent of adults fail to meet physical activity guidelines, a concerning statistic given that physical inactivity is significantly associated with an increased risk of falls.^33-39 Notably, 3 of the top 4 risk factors for falls—muscle weakness, gait impairments, and balance deficits—are directly linked to insufficient physical activity. ³⁶ This begs the question: how does a lack of physical activity increase the likelihood of falling?

This phenomenon is often described as the “Inactivity Fall Risk Cycle.” Essentially, the body adapts to the activities—or lack thereof—that dominate daily life, following the well-known principle of “use it or lose it.” When sedentary behavior becomes the norm, the body undergoes changes, including losses in strength, balance, endurance, flexibility, and even cognitive sharpness. These impairments, in turn, negatively impact functional abilities.

Declines in functional performance can manifest as reduced walking speeds, difficulty rising from a chair or the floor, and challenges with reaching for objects. Such deteriorations in function are closely linked to an increased risk of falling. In more severe cases, a fall can set off a cascade of negative outcomes. Following a fall, individuals often develop a fear of falling, experience pain from their injuries, or lose motivation to remain active—further contributing to physical inactivity and exacerbating the cycle.

Objective 2

Assess the Risk of Falling by Utilizing Practical Evaluation Strategies

Assessing lifestyle factors across the 6 pillars of lifestyle medicine provides valuable insights into an individual’s fall risk. While much of this information is gathered subjectively via questionnaires or interviews, subjective data can sometimes be limited by recall bias, underreporting, or inaccuracies. Therefore, incorporating objective physical assessments is essential to validate findings and identify areas of concern.

This section outlines efficient and straightforward evaluation strategies that require minimal equipment and time, focusing on 3 of the most common fall risk factors: decreased balance, muscle weakness, and gait impairments. ³⁶ These assessments allow for a comprehensive understanding of an individual’s fall risk and can guide targeted interventions or referrals.

Balance Assessment: Single-Leg Stance Test

The single-leg stance test is a widely used tool for evaluating static balance. Evidence suggests that the inability to maintain balance on 1 leg for more than 5 seconds is associated with a significantly higher risk of falls. ⁴⁰ This test involves asking individuals to stand on 1 leg, providing an objective measure of their balance capabilities.

Performance on this test can be tracked over time to monitor changes in balance, such as during annual or biannual evaluations. Additionally, comparing results to normative age-specific values, such as those provided by Springer et al, ⁴¹ can help identify potential deficits that may increase fall risk.

Functional Strength Assessment: 30-Second Sit-To-Stand Test

Functional strength is critical for fall prevention, and the 30-second sit-to-stand test offers an accessible method to evaluate it. This test measures an individual’s ability to repeatedly stand from a seated position and return to sitting, without using one’s arms, within a 30-second period. ⁴² Poor performance on this test has been linked to an increased likelihood of falling. ⁴³

Normative values for different age groups, available in existing research, provide benchmarks to assess individual performance. ⁴³

Gait Assessment: Walking Speed

Walking speed serves as a reliable indicator of functional mobility and fall risk. While average walking speed for adults ranges between 1.2-1.4 meters per second (m/s), research shows that a speed below 0.8 m/s is associated with an increased likelihood of falls. ⁴⁴ Various walking speed tests are available, and the choice of test should consider available space and equipment to ensure safety.

Monitoring walking speed over time is essential, as declines may indicate worsening mobility or an elevated fall risk. Walking speed also correlates with functional independence: individuals walking faster than 0.8 m/s are generally classified as community ambulators, whereas those walking slower face increased risks of hospitalization, functional decline, and falls. ⁴⁵

Importance of Monitoring and Referrals

Identifying deficits in balance, strength, or gait in the medical office through these assessments may suggest the need for referrals to specialists, such as physical therapists, for further evaluation and treatment. Even if individuals do not surpass specific cut-off values, tracking performance annually or biannually can help detect early decline and facilitate timely interventions.

By integrating these physical assessments into routine evaluations, practitioners can adopt a proactive approach to fall prevention, ultimately improving safety and quality of life for at-risk populations.

Objective 3

Communicate fall prevention interventions, emphasizing the connection between lifestyle behaviors and fall risk.

Empowering Physical Activity in Fall Prevention Strategies

By definition, physical activity simply means any movement of the body. ⁴⁶ And when it comes to applying it towards fall prevention, it should be challenging, enjoyable, meaningful, yet realistic. Improvements should be measurable as described in Objective 2. Activities need to be individualized to the person’s needs and interests. Through years of clinical observation, we noted, that if activities were not meaningful or interesting, or even enjoyable, the chances of the individual doing them long-term were slim. Based on the person’s current function, health professional team members can help guide him or her toward sustainable movement goals.

The American College of Sports Medicine (ACSM) and the CDC both promote the following guidelines for adults ⁴⁶ : At least 150 minutes of moderate-intensity aerobic (also known as endurance) activities every week; plus, at least 2 non-consecutive days each week of strength training.

Additionally, there are 2 other movement categories, flexibility and balance, that will be covered later in this paper with regards to fall prevention. As of June 2024, the United States Preventive Services Task Force (USPSTF) released a Grade B recommendation for fall prevention exercise interventions in at-risk individuals 65 years and older. Grade B means there is high certainty that this activity or service improves important health outcomes and USPSTF concludes that the net benefit is moderate enough to outweigh the harms. ⁴⁷

The American College of Lifestyle Medicine (ACLM) has complimentary lifestyle handouts based on each pillar. For the Lifestyle Activity handout, guidelines and types of physical activity are discussed, along with examples. ⁴⁸

Humans are beautifully designed to move. The fall prevention benefits of physical activity include enhanced function, balance, cognition, and emotional state.^18,36,49 The 4 main categories of physical activity, along with their examples for fall prevention, are listed in Table 1.

Table 1.

Physical Activity to Reduce Fall Risk.^48,50

Endurance (aka Aerobics) Examples:	Flexibility Training Examples:
Brisk walking	Yoga and Tai Chi
Yardwork (mowing/raking)	Back stretches
Tennis	Hip stretches
Bicycling	Calf stretches
Swimming	Ankle stretches
Strength Training Examples:	Balance Training Examples:
Squats	Tai Chi and yoga
Lunges	Standing on 1 leg
Wall push-ups	Heel-to-toe walking
Weight-bearing	Qigong
Resistance band exercises	Standing on a foam pad with eyes closed

While the USPSTF fall prevention guidelines focus mainly on older adults, the Canadian 24-Hour Movement Guidelines also include additional recommendations for those under 65 years of age ⁵¹ :

• • Teens and Adults (18 years and older) are recommended to spend less than 8 hours of sedentary time a day

• • Break up sedentary time with movement breaks

In a small yet powerful Randomized Control Trial (RCT) published in 2024 with 116 participants, yoga intervention over a 12-week period combined with a Mediterranean diet was found to improve functional capacities such as gait, strength, flexibility, stability, and balance, in addition to overall health. ⁵² Poses were variable and the yoga flows were able to be performed by the study population ages 65 years and older. ⁵² Benefits seen after a 12-week intervention (yoga training of at least 120 min/wk. including breathing techniques as part of each structured session), combined with a Mediterranean diet, also showed benefits in: mental health, stress reduction, control of obesity, blood pressure, cholesterol, fat %, and more. ⁵²

In 2023, a comprehensive study on the benefits of Tai Chi was published, synthesizing data from 24 RCTs involving adults aged 60 and older. The findings, consistent with previous research above, demonstrated that Tai Chi offers a range of health benefits beyond fall risk reduction. ⁵³ Specifically, Yang-style Tai Chi was found to be the most effective in preventing falls, with its effectiveness increasing as both the duration and frequency of practice were enhanced. In addition to improving balance and reducing fall risks, Tai Chi also contributed to improved cognition, enhanced quality of life, and alleviation of chronic pain, among other benefits. ⁵³

A 2020 systematic review found that a combination of exercises is most effective in preventing falls among adults 65 years and older. ⁵⁴ The findings suggest that health care providers, including general practitioners, geriatricians, nurses, and other health professional team members, recommend regular physical activity, particularly when it incorporates a mix of balance and flexibility training, strength and resistance exercises, aerobic activities, and Tai Chi. ⁵⁴ These combined exercise modalities help improve balance and muscle strength, which are essential for maintaining mobility and preventing falls during aging. The World Health Organization (WHO) recommends that such exercises be performed with a frequency of at least 150 minutes per week, ideally on most days of the week. ⁵⁴

To support the practical integration of fall prevention strategies, the following actionable acronym has been developed. It is designed to facilitate the incorporation of fall prevention and physical activity into daily routines and clinical practice. The acronym “I C TENS” is intended to be easily recalled and applied within the Physical Activity Pillar of lifestyle medicine:

• (1) Increase physical activity by relying less on automation

  • • For example, physically walk to the bank or the store

• (2) Change it up (variety is key)

• (3) Try to end each exercise session on a successful and positive note

• (4) Enjoyable and individualized to the person’s interests and goals

• (5) Need to challenge balance safely (this is how our brains learn and grow)

• (6) Stand up every hour for at least 5 minutes and move

  • • Reach toes, raise heels, march in place, walk around (change it up each time to use different muscles); arm movements in standing, walking, etc.

Empowering Nutrition in Fall Prevention Strategies

Positive dietary choices play a vital role in enhancing overall health and reducing the risk of falls.^55,56 A well-balanced, whole-food, plant-predominant diet not only strengthens bones and improves muscle health but can also boost cognition and promote overall well-being, making it a powerful tool for fall prevention. ⁵⁵

Furthermore, eating to support muscle health requires a variety of fiber or plant diversity, and lower meat and dairy consumption. ⁵⁵ This eating pattern is found to be associated with a lower prevalence of sarcopenia, which is defined as age-related loss of muscle mass, strength, and function (starting after the age of 30).^55,56

This section will focus on proper nutrition to help slow the progression of sarcopenia, which accelerates with age, leading to frailty, reduced mobility, and a higher risk of falls.

So, let’s eat in a way that we can get some “PIES”^55-57:

• • Promote strong bones

• • Improve cognition

• • Enhance muscle parameters

• • Savor well-being

First, remember, that nutritional status is 100% modifiable! It is important to have fun with nutritious and delicious foods by getting to know the colors of vegetables and fruits and their diverse benefits. Seeking a variety of minimally processed and tasty wholesome foods is the utmost of importance. For those facing challenges in accessing proper nutrition, innovative solutions such as community support programs or food delivery services can assist. ⁵⁸

Examples from a 2023 article titled “Nutritional strategies to optimize musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein” are highlighted below ⁵⁵ :

• →Example: Green leafy vegetables = are antioxidants and a rich source of non-heme iron (iron deficiency anemia is a risk factor for poor muscle function)

• →Example: Cruciferous vegetables = are important in musculoskeletal health contributing to muscle function and bone strength, especially in older adults

With every increase of 1 different vegetable per day, there was an association of an 8% lower risk of an injurious fall and a 9% lower risk of fracture. ⁵⁵ Additional nutritional considerations include^{4,6,52,56,59,60}:

• • Vitamin D level (optimal goal clinically: 50s-80s ng/mL 25-Hydroxy-Vitamin D-3)

• • Protein intake (10-35% of daily energy intake) based on the individual’s needs

• • In older adults with sarcopenia, combining D3 with protein supplementation and exercise has demonstrated several benefits:

  • ○ Tendency to increase muscle mass
  • ○ Increased grip strength
  • ○ Enhanced muscle function
  • ○ Improved bone health
  • ○ Reduction in sarcopenia progression
• • Antioxidants:

  • ○ Play a crucial role in mitigating oxidative stress, which is implicated in the development of sarcopenia, via the following processes:

    • ■ Neutralizing free radicals
    • ■ Reducing inflammation
    • ■ Improving mitochondrial function
    • ■ Supporting protein synthesis
    • ■ Enhancing recovery

As a rule of thumb, the ACLM Dietary Spectrum handout provides a visualization of a plateful of nutritious, antioxidant-rich foods as compared to a “standard American diet” (SAD) plate. ⁶¹ Additionally, Canada’s Food Guide also recommends that fiber-rich foods should make up approximately 50% of every plate of meal. ⁶²

Empowering Sleep in Fall Prevention Strategies

Restorative sleep has been shown to enhance both physical and cognitive functions. ⁶³ However, as highlighted in Objective 1, poor sleep quality is associated with an increased risk of falls. This issue is not limited to older adults, as insufficient sleep quality and quantity can affect individuals of all ages. ⁶⁴ Given these findings, it is crucial for healthcare professionals to inquire about patients’ sleep habits as part of fall prevention efforts. General recommendations for sleep and fall prevention include the following^9,64,65:

• • Be educated on the importance of sleep duration to reduce risk of falling and fall-associated fractures

• • Limit activities in bed to sleep and sex only

• • Understand BOTH quality and quantity of sleep is equally important

  • o Seek simple tips on improving sleep with this phrase below

    • ⁃ Ready → Get → Set → Go → Start → Stop^66-69:
    • ⁃ Ready for bed before 11pm, gradually start sleeping even earlier
    • ⁃ Get more daytime physical activity
    • ⁃ Set Night-Time mode for ALL electronic devices after sunset
    • ⁃ Go to bed and wake up at the same time each day
    • ⁃ Start developing a bedtime routine to promote sleep, for example, deep breathing, mindfulness, etc.
    • ⁃ Stop blue lights 2-3 hours before targeted sleep time, for example, keep the bedroom dark and quiet with cool temperature, etc.

• • Refer for a take-home sleep study or to a sleep specialist

Empowering de-stress in Fall Prevention Strategies

As shared earlier, stress can increase muscle tension, leading to restricted movements and impaired balance. And one of the most familiar stress inducers of them all is “rushing.” In fact, in our fast-moving world, rushing has become the “new norm” just because it is so common. When we rush to complete our to-do list, we could really increase our fall risk.^17,70 While stress has been shown to have negative effects on the body, relaxation can improve stability and focus, decrease stiffness, and reduce the fear of falling.^52,53,70

Some simple solutions for stress transformation include:

• • Perform breath work and laughter exercises

  • (a) Diaphragmatic breathing, aka “Belly breathing,” studies have shown the benefits of deep breathing to overall health, specifically for falls.^13,14,17
  • (b) Nostril breathing, focusing on prolonged exhalation, activates the parasympathetic nervous system. ⁷¹
  • (c) Laughing reduces stress and can improve core strength. ¹⁷

• • Consider training based on relaxation^52,53 (e.g., Yoga and Tai Chi)

• • Apply our D.E.S.S.E.R.T.S. Method (8-Steps):

  • (1) Deeply breathe
  • (2) Exercise consistently
  • (3) Sleep soundly
  • (4) Surround ourselves with supporters
  • (5) Eat the foods that love us and our bodies back
  • (6) Relax mindfully in nature
  • (7) Try something new
  • (8) Share our stories and laughter

Empowering Positive Social Connections in Fall Prevention Strategies

There is a relationship between lack of social connections and falls due to the psychosocial consequences post-falls, including fear of another fall.^18,20,21,72 Therefore, the human population should avoid social isolation and encourage more engagement. For example, we can incorporate group exercises, like (Chair) Yoga or (Chair) Tai Chi, in the community. According to a longitudinal analysis over 20 years in the Framingham Heart Study, happiness, as an emotional state, can spread up to 3 degrees of separation within a social network. ⁷³ If one individual is happy, it increases the likelihood that their friend’s friend—someone who may not directly interact with the original individual—could also experience heightened happiness.

Extending this principle to health-related behaviors or outcomes, such as the risk of falling, implies a similar influence. If someone adopts habits or environmental adjustments that reduce their risk of falling, these practices might indirectly influence their social network. For example:

• • Behavioral Modeling: If one person actively improves their physical fitness, practices balance-enhancing exercises, or modifies their home environment for safety, their friends may observe and adopt similar behaviors. These friends might, in turn, share these changes with their own networks, leading to a cascading effect.

• • Emotional and Psychological Effects: A reduced fear of falling in one individual might boost confidence and encourage mobility within their social network. Confidence and emotional resilience are contagious, much like happiness, and this shared positivity could decrease fall-related anxiety for others within the network.

• • Shared Resources and Information: Social networks often share tips, strategies, or resources. If one individual gains knowledge about fall prevention—whether through medical advice, community programs, or personal experience—they are likely to share it, influencing friends and potentially their extended networks.

The idea, therefore, is that the interconnected nature of human relationships allows health and well-being to spread in ways similar to emotions like happiness. This underscores the importance of fostering positive health behaviors within a community or group, as the benefits may extend far beyond the individual.^72,73

Empowering Avoidance of Risky Substances in Fall Prevention Strategies

The use of risky substances, including certain medications, represents a modifiable risk factor that should be addressed to mitigate fall risk. These risks are often compounded by the dose-dependent nature of these substances, as higher doses amplify side effects, thereby increasing susceptibility to accidents and injuries. While abstinence remains a crucial strategy, additional considerations are essential for comprehensive risk reduction^25,28-30,74:

• • Understand the adjustment period: Account for the time it takes for individuals to adapt to medication/substance initiation, changes, or discontinuation.

• • Review prescription medications for interactions: Evaluate the potential for adverse drug interactions, particularly in cases of polypharmacy (≥5 medications).

• • Refer to a specialist: Consult professionals with relevant expertise, such as addiction counselors or geriatricians, for complex cases.

• • Provide resources: Offer accessible educational materials and support to patients and caregivers.

• • Lifestyle choice swaps: Create opportunities to adopt healthier habits (as habits can be harder to break than the addiction to any risky substances).

  • ○ Example 1: Rather than reaching for a cigarette, reach for a palm-size serving of fruits/nuts/seeds as a snack
  • ○ Example 2: Instead of choosing alcohol after a stressful day, brew some calming herbal teas to sip on.

Health professional team members must consider how staying active can increase the effectiveness of certain medications, which may require tapering or weaning of these meds if they pose a fall risk over time, especially while an individual is pursuing a healthier lifestyle. For example, one may need to drop the doses of blood pressure and/or blood sugar meds over the course of time before potentially discontinuing them to prevent hypotension and/or hypoglycemia, respectively. A multifaceted approach is critical to effectively reduce fall risks associated with substance use and medication management.

Summary and Discussion

Oftentimes, we have less than one second to regain our balance when we lose it. ⁷⁵ Fall prevention should start much earlier than age 65; falls affect people of all ages. Therefore, everyone is encouraged to apply evidence-based strategies and to practice starting now; do something to reduce the risk of falling. The best way for any fall prevention program to work is to integrate positive lifestyle changes as part of the implementation.

In modern health care, the escalating incidence of falls has emerged as a paramount concern, representing the primary cause of unintentional injuries leading to ER visits across all age groups.^1,2 Recent data from the CDC emphasizes the severity of this issue, highlighting the urgent need for a comprehensive and collaborative approach to address and alleviate fall-related injuries.^1,2 The economic impact of falls underscores the importance of proactive fall prevention measures for both individual well-being and health care system sustainability. In this context, health professional team members play an indispensable role, standing at the forefront to bridge the gap between the realms of lifestyle medicine and fall prevention. Professional expertise becomes a crucial element in devising and implementing strategies that seamlessly align with the principles of lifestyle medicine, ensuring a proactive and holistic approach to mitigate the widespread public health challenge posed by falls.

The strategic alignment with the 6 pillars of lifestyle medicine forms the bedrock of the approach to fall prevention advocated in this paper. These pillars, encompassing nutrition, physical activity, sleep, stress management, social connections, and the avoidance of risky substances, provide a comprehensive framework to address the multifaceted nature of fall risk.

Nutrition

Positive dietary choices are crucial for enhancing overall health and reducing the risk of falls. A balanced whole-food, plant-predominant food plan supports strong bones, enhances muscle health, improves cognition, and promotes well-being, thus mitigating fall risk.

Physical Activity

Regular exercise and physical activity play a crucial role in maintaining our health and well-being. Activities that focus on improving muscle strength, flexibility, power, coordination, and balance can directly contribute to fall prevention.

Sleep

Both the quality and quantity of sleep are vital for overall health and well-being. Poor sleep habits can result in fatigue and impaired alertness, elevating the risk of accidents and falls. In contrast, restorative sleep enhances overall physical and cognitive functions, thus reducing the risk of falls.

Stress Management

Persistent stress can influence both physical and mental health, impacting elements associated with an increased risk of falls, such as heightened muscle tension and altered cognitive function. Mindfulness practices, such as meditation and relaxation techniques, can help reduce stress, thus improving balance and coordination.

Social Connections

Social engagement correlates with improved physical and mental health. Maintaining social connections offers emotional support, reduces feelings of isolation or fear of falling, and positively impacts mental well-being, all of which contribute to fall prevention.

Avoidance of Risky Substances

Harmful behaviors, such as smoking and excessive alcohol consumption, can compromise physical health and increase the risk of unintentional injuries, including falls. Alcohol impairs balance, coordination, and reaction time, while smoking reduces bone density and may lead to peripheral neuropathy.

Collaboration in enhancing all the pillars mentioned above is crucial for achieving success. Health professional team members who possess clinical knowledge and skills are positioned to use the lifestyle medicine pillars as the foundation for assessments, education, recommendations and referrals with targeted interventions to effectively reduce the likelihood of future falls.

Additionally, each ACLM lifestyle handout highlights S.M.A.R.T. Goals for the readers to create and work on that specific pillar. For example, we turned these goals into fall prevention-related questions.

Setting S.M.A.R.T. Goals to reduce fall risk:

Specific: What exactly are you going to do to reduce your risk of falling?

Measurable: How will you monitor your fall risk reduction?

Achievable: How confident are you to follow through with your goals (e.g., on a scale from 1-10)?

Relevant: What are your limits vs potentials?

Time-bound: How often and how long will you keep up with the activities to help prevent falling?

By understanding and optimizing the efforts of health professional team members, patients, and the broader community, the goal is to empower all stakeholders. This inclusive model is designed to make fall prevention education accessible to everyone, regardless of age or background, by equipping them with the knowledge and tools to take immediate and informed action. This paper emphasizes the positive impact of working together and aims to bring about a comprehensive change in addressing the crucial issue of falls. This collaborative shift encourages community-wide participation, aiming to create a society that is well-informed, watchful, and collectively committed to reducing the number of falls.

In conclusion, the need to address falls as the leading cause of unintentional injuries demands a coordinated effort from health professional team members and the broader community in order to make a profound impact. By imparting strategies rooted in lifestyle medicine, we become pivotal catalysts for change, fostering a proactive and informed approach that resonates across all segments of society. This paper serves as a beacon for a future where fall-related injuries are significantly minimized, and individuals are empowered to lead healthier, safer lives.

ORCID iD

Nhi Ma Do https://orcid.org/0009-0007-5291-7186